Happy New Year from all at the MJA! Among other things, 2008 is the United Nations International Year of the Potato, an initiative designed to raise awareness of “the importance of the potato -- and of agriculture in general -- in addressing issues of global concern, including hunger, poverty and threats to the environment”. Apparently, potatoes have been underestimated as a source of nutrition in less developed nations. Potatoes can produce more nutritious food, more quickly, on less land, and in harsher climates than any other major crop. World potato production is increasing as countries in which potato farming has not been traditional realise the potential benefits of change.
Australia, too, is poised for change. Authors writing in the MJA have for some time been calling for a fresh approach to some of the major issues confronting the nation’s health. With a new federal government in Canberra, we wonder if some of the calls for change will be heeded, and what form the changes will take. As you read this issue, take heart from the potato story: solutions to complex problems might be closer at hand than you think.
So long staph
We already know what to do about the high rates of methicillin-resistant Staphylococcus aureus infections in our hospitals, says Collignon (→ Methicillin-resistant Staphylococcus aureus (MRSA): missing the wood for the trees ) in response to a study by Kotsanas et al, which identifies the dangling cacophony of lanyards, badges, keys and pens that hang around doctors’ and nurses’ necks as a potential source of nosocomial infection (→ What’s hanging around your neck? Pathogenic bacteria on identity badges and lanyards). Regular hand hygiene is paramount, along with better surveillance, appropriate handling of known cases, reduced overcrowding, and isolation protocols. These sentiments are echoed by several experts in our Letters (→ Methicillin-resistant Staphylococcus aureus in hospitals: time for a culture change). “What we appear to lack is an understanding of human behaviour and the political and medical will to really do something about it. It is time to change. We have been missing the big picture for too long”, concludes Collignon.
Smokers, snus and stealth
Snus, a tobacco product used in Sweden that is not smoked, but absorbed from the mouth over a long period, should be available in Australia for inveterate smokers who want to use a less risky form of tobacco than cigarettes, argue Gartner and Hall (→ Should Australia lift its ban on low nitrosamine smokeless tobacco products?). There is good evidence that snus is much less carcinogenic than cigarettes and does not increase the user’s risk of cardiovascular disease. But Chapman offers a word of caution (→ Repealing Australia’s ban on smokeless tobacco? Hasten slowly) — the tobacco industry has shown itself as “resourceful, rapacious and duplicitous”, and will seize any opportunity to retain and increase its market.
The Bindeez report
Late last year, doctors from the Children’s Hospital at Westmead and the NSW Poisons Information Centre were the first in the world to make the link between the children’s toy, Bindeez, and γ-hydroxybutyrate poisoning in children, leading to an international recall of the product (Gunja et al, “γ-Hydroxybutyrate poisoning from toy beads”). In reporting the process that led to their discovery, the authors celebrate the effectiveness of poisons centres in toxicovigilance and monitoring of potential clusters of poisoning, and the ability of global toxicological networks to efficiently spread the news — one initiative in Australia that possibly doesn’t need to change!
The regulation of complementary medicines in Australia requires reform, say Harvey et al (→ Commercialism, choice and consumer protection: regulation of complementary medicines in Australia). While prescription drugs and other pharmaceutical products must be registered after evaluation by the Therapeutic Goods Administration for quality, safety and efficacy, most complementary medicines need only be listed via a far less rigorous and cheaper process. The end result? A proliferation of dubious products, complaints and consumer confusion. Also under scrutiny is the process by which the government decides to fund expensive pharmaceuticals. Clinical and cost-effectiveness are always assessed but, as Raftery discovered when he compared funding decisions for the same 10 drugs in Australia, the United Kingdom and New Zealand, there are often other influences brought to bear (→ Paying for costly pharmaceuticals: regulation of new drugs in Australia, England and New Zealand). Meanwhile, a study based on Bettering the Evaluation and Care of Health data indicates that general practitioners who are exposed to drug advertising in clinical software are not more likely to prescribe the advertised drugs than those using software without advertisements (Henderson et al, “The effect of advertising in clinical software on general practitioners’ prescribing behaviour”). Whether or not this will deter pharmaceutical companies from using this form of advertising depends on what they hope to achieve from it, observes Mansfield (→ Do advertisements in clinical software influence prescribing?).
Another time . . . another place
Charles V Chapin, 1917
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